regional committee
PAN AMERICAN
WORLD
a/
ORGANIZATION
ORGANIZATION
XIII Meeting XIII Meeting
Washington, D. C. October 1961
CD13/30 (Eng.) 14 September 1961
ORIGINAL: SPANISH
Topic 9: 'PROPOSED PROGRAM AND BUDGET OF THE PAN AMERICAN HEALTH ORGANIZATION FOR 1962
In accordance with Article 3.4 of the Financial Regulations, the proposed program and budget for the Pan American Health Organization for 1962 was submitted to the 43rd Meeting of the Executive Committee for
examination. The recommendations for the Executive Committee are contained in its report (Document CE43/18, Rev. 1, Annex I) which is attached hereto and is submitted in accordance with Resolution I which reads as follows:
"The Executive Committee,
Having studied in detail the provisional draft of the proposed program and budget of the Pan American Heal.th Organization for 1962
contained in Official Document No. 31, with the modifications thereto appearing in Document CE43/2, prepared by the Director;
Considering that the XII Directing Council in Resolution X recognized that the provisional draft of the Proposed Program and Budget for 1962 appearing in Official Document No. 31 comprised well-conceived and much-needed health projects;
Considering that the modifications appearing in Document CE43/2 were made after consultation with each Government and reflect the latest known desires and requirements of Governments with due regard to priorities of needs; and
Considering the terms of Article 12-C of the Constitution of the Pan American Health Organization and paragraphs 3.5 and 3.6 of Article III of the Financial Regulations of the Pan American Health Organization,
CD13/30 (Eng.) Page 2
RESOLVES:
1. To submit to the XIII Meeting of the Directing Council
the Proposed Program and Budget of the Pan American.Health Organization for 1962, prepared by the Director (Official Document No. 31 and
Document CE43/2), together with .the report containing the-observations and zqcommendations made by this Committee (DocumehitCFA3/],Rev. 1
2. To recommend that the Directing Council establish the budget level of the Pan American Health Organization for 1962 at
$5,240,000."
The Proposed Program and Budget for 1962 contained in Official Document No.. 31 and CE43/2, has been incorporated into Official Document No. 35, which has been distributed separately and is ·submitted-for considera-tion by the Directing Council.
. CE43/18, Rev. 1 (Eng.) ANNEX I
REPORT OF THE EXKECUTIVE CPMMITTEE TO THE DIRECTING
COUNCIL ON THE PROPOSED PROGRAM AND BUDGET OF THE
-PAN AMERICAN HEALTH. ORGANIZATION FOR 1962
Introduction
At the second, third, fourth and ninth plenary sessions of its 43rd
Meeting, the Executive Committee examined the Proposed Progras.and Budget
of the Pan American Health .Organization for 1962 (Official Document No.
31 and..Document CE43/2), prepared by the Director of the Pan American
Sanitary Bureau.
The Director, before entering on a discussion of PAHO's Regular
Program and Budget for 1962, presented to the Executive Committee some
considerations of a general nature on the activities of the Organization
which in total constitute a unified and functional program despite the'
widely diverse origin of the funds. In addition to the various funds
coming through the Pan American Health Cra'uization and the Worid Health
Organization, as reflected in the budget documents, the Organizationh is'
constantly trying to find more resources for health activities. Some
additional funds have already been obtained for research; other funds
have been mobilized indirectly inin the form of loans to Governments for
community water supply systems.
In the opinion of the, Director, public health organizations, both
international and national, now have a double responsibility. There are
CE43/18, Rev. 1 (Eng.) ANNEX I
Page 2
such activities. There is, in addition, a complementary responsibility
relating to economic development and social progress of which public health
is an integral component. There are few activities either in the public
or private sector in which public health is not concerned, whether in
agriculture and land use, industrialization and urbanization,
trans-portation, housing, education, or whatever. The role of public health
organizations may be exercised in the direct protection of human beings
or through improvement of their environment. It is urgent to convince
public authorities that funds devoted to health are not just an
expendi-ture but are an investment. Failure to grasp this concept is resulting,
in some countries, in a steadily diminishing proportion of national
income andwnational budgets being devoted to health. Health leaders
have been devoting most of their time to specific functions but should
give increased emphasis to promoting health as an integral part of total
economic and social development. Ministers of health need to participate
in national planning councils to assure that health programs make a full
contribution to integrated.and balanced economic and social development
in order to obtain maximum results from available human and natural
resources.. The Organization has been actively engaged in promoting this
concept, contacting organizations charged with granting loans or
develop-ment funds, and cooperating with other agencies to amplify the scope of
heaith in economic development and social welfare.
The Director reviewed with the Executive Committee the tables on page
CEa43/18, Rev. 1 (Fng.)
ANNEX I page 3
classification, both in major groups corresponding to the principal
program objectives of the Organization and by individual subjects. It
was recalled that this analysis was studied by the XII Directing -Coucil'
which, in Resolution X, recognized "that the provisional draft of the
proposed program and budget comprises well-conceived and much-needed
health projects" 11 ...
Attention was called to the fact that the Proposed Program and
Budget of the Pan American Health Organization represents an increase
of 9.78 per cent over 1961. The Regional Budget of the World Health'
Organization shows an increase of 11.07 per cent, while WHO/TA funds
dropped about 1 per cent. With respect to the increase for'the Pan
American Health Organization a study has shown that 4 per cent was
necessary to meet increased operating costs, principally higher common
staff costs;and local.salary increases. Thus, qnly alittle over 5
per cent is available. fo r expanding the work of the Organization...
Before preparing the Program and Budget for presentation to the '
Directing Council, the Director again consulted with individual
Governments. Document CE43/2 therefore reflects the latest known desires
and requirements of Governments. The Director explained a change'in. the
style of presentation in which the common staff costs formerly presented
as a lump sum for each of Parts I and II are now presented by chapters,
This is a step toward a more understandable budget and facilitates
re-view of the total costs of each office. Document CE43/2 was presented
item by item with explanations as needed.
CE43/18, Rev. 1 (Fng.)
-AEX I Page 4
Program Comments
General Program
The Committee Members accepted and reiterated the general concept
of the role of health presented by the Directors, emphasizing the
funda-mental role of health in economic and social development. It is
con-sidered important that ministers of health should find ways to
partici-pate more actively in national planning. The need for balanced
develop-ment implies an increase in health activities both in value and scope.
The Committee expressed appreciation for the activities of the
Organization in promoting this new concept of health responsibility and
in mobilizing greater resources for health activities both directly and
indirectly. This role was particularly evident in the Act of Bogota.
The Committee found that the program revisions, some resulting
from modifications required by increased costs and others reflecting
the changing requirements of Governments, do not substantially alter
the program balances The Committee recalled that the XII Directing
Council had reviewed the provisional draft and found that it comprised
well-conceived and much-needed projects. In the course of the detailed
consideration of the Program and Budget, certain subjects were explained
more fully as set forth in the following paragraphs:
Leprosy .''"
-It was noted that the work of the consultant in Zone III had to
CEl43/18, Rev. 1 (Eng.) ANNEX I
Page 5
Director reported that in a recent meeting of ministers of public health
in Tegucigalpa, Honduras, an analysis of the problem showed that the
presence of the consultant and the presentation of short courses for the
training of professionals in each country, had resulted in doubling or
tri-pling the number of cases known in some countries, thus emphasizing the
need for oontinuling the work of the consultant. It was also reported that
UNICEF has indicated a readiness to cooperate through the provision of
equipment and drugs for leprosy campaigns. In Zone IV it was noted that
a Zone: consultant for leprosy will be provided to work in all countries
rather than a consultant for each country as originally planned.
Nutrition
In relation to project AMRO-54, the Director announced that Dr.
Scrimshaw, present Director of INCAP, has accepted a new position as
Director of the Institute for Studies in Nutrition and Food Technology
at the Massachusetts Institute of Technology (MIT). This new Institute
will certainly be of world-wide importance in nutrition research. -It
has been possible, however, by arrangements with MIT, for Dr. Scrimshaw
to continue as Technical Director-Consultant for at least three months
per year. Dr. Moises BIhar, Guatemala, will fulfill the function of
Director of INCAP. The name of INCAP is now known throughout the entire
world, as is INCAPARINA, which represents one of its major scientific
achievements. The Governments of Sudan and Thailan'd are now interested
to see if the principle. and preparation of this product can be applied
n ther country. , .
in their country. :.
CE43/18, Rev. 1 (Eng,) ANNEX I
Page 6
Smailpox
Note was taken of the fact that the smallpox project in Colombia
will not be needed for 1962 as the campaign has already been completed
and the consolidation phase is expected to terminate in 1962. Members
of the Committee congratulated the Government of Colombia on this
achievement.
Tuberculosis
The project for control of tuberculosis in Argentina is being
re-vised to collaborate with the Government in the creation of a training
centers which will be available to all countries in the Region. The
appearance of new drugs has produced in the medical world a false
impres-sion that this problem has been solved. Consequently the number of
professional personnel trained in this field has diminished sharply, and
the need now arises to establish new training facilities.
Planning and Organization of Hospital Service.
Note was taken of the increase of activities in this field in
several countries of the Americas. Members of the Committee reflected
the growing interest of Governments and the realization of the need for
international consultant services and training.
Diarrheal Diseases in Childhood
The Committee discussed the importance of the diarrheal diseases
CE43/18, Rev. 1 (Eng,) ANNEX I
Page 7
ways, directly and indirectly, through research projects carried out by INCAP
find elsewhere, through projects for environmental sanitation, and through
health education and maternal and child health, and portions of integrated
public health programs; nevertheless, the Ccmmittee felt that specific
projects on this subject 'should appear in the budget in order to emphasize
its importance in the field of health. The Director expressed the hope that
the new Regional Consultant in Maternal and Child Healths who will Join the
Or-ganizatirn in 1961, will promote important additional activities in this field.
Plague
The Director explained that the absence of a project for this
subject did not imply any lack of attention. On the contrary, an
inter-nationally known consultant is now engaged in establishing the basis for
a thorough epidemiological study of this disease to be carried out along
the frontier of Peru and Ecuador.
Nursing Education
The Committee praised the work of the Organization in nursing
education and expressed appreciation for the inclusion:in the proposed
program of a seminar in advanced nursing education (AMRO-46). Many
countries are now recognizing the importance of having qualified nurses
in administrative and supervisory positions and are taking steps to raise
salaries and to provide expanded and higher level trair.ing facilitieo.
CE43/18, Rev. 1 (Ern.)
ANNEX I
Page 8
Integrated Public Health Services
In the examination of various projects of this type, the Director
re-ported that the Office of Evaluation of. the World Health Organization has
carried out an evaluation study of the project in Paraguay after 10 years
of operation. The preliminary report shows that the progress realized by
Paraguay in this period is important and worthy of further support.
In a recent meeting of ministers of health in Central America and
Panama, there was unanimous agreement to request the Organization to
evaluate the public health service of the six countries of the area.
Budget Level
After completing a line.by.line review of the program the Committee
considered the budget level for 1962 and the general problem of increases
in future years. They noted that the proposed increase for 1962 amounted
to $440,000 or 9.17 per cent over the level for 1961.
Three of the Members expressed their concern with the trend of budget
increases among international organizations. While praising the work of
the Organization they felt that increases should be more strictly limited
in order to stay within the capacity of Member Governments to pay.
Four Members supported the budget increase. While also concerned with
the problem of Member Governments in meeting their quotas, they believed
that the services of the Organization and its international consultants
pFlY a key role in the improvement of national health programs which are
'CE143/18, Rev. 1 (Thg.)
ANNEX I
Page 9
Dr. Bichat Rodrigues (Brazil) stated that the Committee found itself
in a difficult position. Having seen how carefully the budget was prepared
and, having noted the long list of requests of governments which could not
be met, it was obvious there is a constant pressure for budget increases.
On the other hand, his Government is concerned over the tendency toward
repeated budget increases among international organizations. He considered
it necessary to establish a formula for limiting increases and asked for
a limit of 5 per cent for increases in the work of the Organization.
Dr. Martinez Marchetti (Argentina) shared the concern about the
budget increases. He expressed the hope that a greater proportion of the
budget could be devoted to field progrmsr.
Dr. Bravo -(Chile) referred 'to the'problem of production in relation
to economic development. He rep6rted'economists as saying that, with'the
highest population increase rate in the world the needs in Latin America.
are growing faster than. resources. The population growth-creates demand
for increased health services, so that it is very difficult to reduce the
activities of PAHO. On the other hand health must be considered within
the national.economy of each country. Consequently it is necessary to
exercise caution with respect to health budgets, both national and
inter-national. It is necessary to establish a rhythm of increases which is
economically feasible ' '
Dr. Orellana (Observer, Venezuela) commented that there is practically
no limit to the possibilities for constructive investment in health. On the
other hand caution needs to be exercised to stay within the financial limits
CE43/18, Rev. 1 trr.' ANNEX I
Page 10
Dr. Angulo (Colombia) expressed his support of the proposed budget.
He spcke of the maximum effort which his country and others are ramkirg
within their capacities, both human and economic, to accelerate the process
of economic and social development. Since health is an essential element
in this national development, countries should be prepared to contribute
the small amounts which the quota assessments represent. He stated that
a prime necessity is for trained personnel qualified to plan and execute
programs. The rate of progress to date could not have been achieved without
the services of international consultants.
Dr. Lara Zepeda (Honduras) recognized the problem which each
govern-ment faces in finding resources to meet its quotas to international
organizations. On the other hand it was necessary to take account of the
importance of assuring steady growth in the work of the Organization.
His country would not have progressed so far if it had not been for the
technical and material help of the Organization. His country is prepared
to make sacrifices to meet its share of the cost of the Organization.
Dr. Aguilar Rivas (El Salvador) supported the proposed Program and
Budget, while expressing a desire to avoid future increases unless they were
within the capacity of the Governments to pay.
Dr. Osborne (United States of America) pointed out that many governments
realize the need to achieve a balanced program in the economic and social
fields, Since health is an important part of this development it must be
expanded. This is true of all countries at whatever stage of development,
CE43/18, Rev. 1 (Endg '
ANNEX I Page 11
need more of'the services of the: Organization,: and this requires steady .
growth. The program and budget of theOrganization cannot remain static.
Dr. Horwitz (Director,' PASB) expressed concern that despite the
im-portance 'of health as an essential part of national development the
percent-age of national inccme devoted it in many countries shows a tendency ..to
decrease. 'At previous meetings of Governing Bodies the question of rate
of growth for the Organization had been discussed. In 1958 delegates to
the XV Pan American Sanitary Conference considered, in view of the
in-creasing cost of living, that an annual increase in the order of 10 per
cent was reasonable. Delegates to the XII Directing Council in discussing
the provisional draft of this budget for 1962 found that the proposed
increase was considered reasonable within the normal terms of increases
proposed in international organizations, especially when considering the
increasing demand for services and the large number of requests which
would still be unmest. It was necessary to bear in mind that an increase
of at least 4 per cent is necessary to meet higher personnel and other
costs arising from increased cost of living. This leaves only about
5 per cent for expanded activities, which is very low in relation to the
demand for services,
Reconmendations
The Committee accepted the Proposed Program and Budget as
consti-tuting a well-conceived and much-needed program. The Committee agreed
CE43/18, ev. . (Eng.) ANNEX I
Page 12
development of the activities the Pan American Health Organization, and
the Committee recommended its adoption to the Directing Council.
It Was recognized that an increase of about 4 per cent is needed
to meet the increased costs of the present level of operations. A further
increase of 5 per cent for expansion of the work of the Organization is
considered the minimam needed to support the proposed program which has
